GOVERNMENT OF THE PEOPLE'S REPUBLIC OF BANGLADESH

NATIONAL BOARD OF REVENUE

Mushak-9.1
VALUE ADDED TAX RETURN FORM
[See Rule 47(1)]
[Please read the instructions before filling up this form]
Part - 1: TAXPAYER'S INFORMATION
(1) BIN : 001999344-0208
(2) Name of Tax Payer : Safe International

(3) Address of Tax Payer : 39,Malibag Chowdhury Para,Rampura

(4) Type of Ownership : Proprietorship

(5) Economic Activity : Imports & Supply

Part-2: RETURN SUBMISSION DATA

(1) Tax Period : ,August-2021
(2) Type of Return :
(Please select your desired option) (A) Main/original Return (Section 64) √ Selecti
(B) Late Return (Section 65)

(C) Amended Return (Section 66)

(D) Full or additional or alternative Return (Section 67)

(3) Any activities in the last tax period? √ Selecti

: Yes No
[If Selected "No" Please Fill Only the relevant Part]
(4) Date of Submission : 14/9/2021

Part-3: SUPPLY - OUTPUT TAX

Nature of Supply Note Value (a) SD (b) VAT (c)
Direct Export 1 Sub-form
Zero Rated Goods/Service
Deemed Export 2 Sub-form
Exempted Goods/Service 3 Sub-form
Standard Rated Goods/Service 4 - - - Sub-form
Goods Based on MRP 5 Sub-form
Goods/Service Based on Specific VAT 6 Sub-form
Goods/Service Other than Standard Rate 7 Sub-form
Retail/Wholesale/Trade Based Supply 8 3,576,687.89 178,834.39 Sub-form
Total Sales Value & Total Payable Taxes 9 3,576,687.89 178,834.39

Part-4: PURCHASE - INPUT TAX

1. If all the products/services you supply are standard rated, fill up note 10-20.
2. All the products/services you supply are not standard rated or input tax credit not taken within stipulated time period under section 46, fill up note 21-22.
3. If the products/services you supply consist of both standard rated and non-standard rated, then fill up note 10-20 for for the raw materials that were used to
produce/supply standard rated goods/services and fill up note 21-22 for the raw materials that were used to produce/supply non-standard rated goods/services and show the
value proportionately in note 10-22 as applicable.

Nature of Purchases Note Value (a) VAT (b)

Local Purchase 10 Sub-form
Zero Rated Goods/Service
Import 11 Sub-form
Local Purchase 12 Sub-form
Exempted Goods/ Service
Import 13 Sub-form
Local Purchase 14 Sub-form
Standard Rated Goods/Service
Import 15 Sub-form
Local Purchase 16 Sub-form
Goods/Service Other than Standard Rate
Import 17 Sub-form
Goods/Service Based on Specific VAT Local Purchase 18 Sub-form
From Turnover Tax Units 19 Sub-form
Goods/Service Not Admissible for Credit (Local Purchase)
From Unregistered Entities 20 Sub-form

Goods/Service Not Admissible for Credit (Taxpayers who sell ONLY Local Purchase 21 Sub-form
Exempted / Specific VAT and Goods/Service Other than Standard
Rate/Credits not taken within stipulated time) Import 22 2,682,381.71 Sub-form
Total Input Tax Credit 23 2,682,381.71 -

Part-5: INCREASING ADJUSTMENTS (VAT)

Adjustment Details Note VAT Amount
Due to VAT Deducted at Source by the Supply receiver 24 Sub-form
Payment Not Made Through Banking Channel 25
Issuance of Debit Note 26
Any Other Adjustments (please specify below)
27
Office Rent
Total Increasing Adjustment 28 -

Page 1 of 11
 Part-6: DECREASING ADJUSTMENTS (VAT)
Adjustment Details Note VAT Amount
Due to VAT Deducted at Source from the supplies delivered 29 Sub-form
Advance Tax Paid at Import Stage 30 134,119.09 Sub-form
Issuance of Credit Note 31
Any Other Adjustments (please specify below)
32

Total Decreasing Adjustment 33 134,119.09

Part-7: NET TAX CALCULATION

Items Note Amount(Tax)
Net Payable VAT for the Tax Period (Section-45) (9c-23b+28-33) 34 44,715.30
Net Payable VAT for the Tax Period after Adjusted with Closing Balance and balance of form 18.6 [(34-(52+56)] 35 (43,267.88) Note 3
Net Payable Supplementary Duty for the Tax Period (Before adjustment with Closing Balance) [9b+38-(39+40)] 36
Net Payable Supplementary Duty for the Tax Period after Adjusted with Closing Balance and balance of form 18.6
[36-(53+57)] 37
Supplementary Duty Against Issuance of Debit Note 38
Supplementary Duty Against Issuance of Credit Note 39
Supplementary Duty Paid on Inputs Against Exports 40
Interest on Overdue VAT( Based on note 35) 41
Interest on Overdue SD ( Based on note 37) 42
Fine/Penalty for Non-submission of Return 43
Other Fine/Penalty/Interest 44
Payable Excise Duty 45
Payable Development Surcharge 46
Payable ICT Development Surcharge 47
Payable Health Care Surcharge 48
Payable Environmental Protection Surcharge 49
Net Payable VAT for treasury deposit (35+41+43+44) 50 -43,267.88
Net Payable SD for treasury deposit (37+42) 51
Closing Balance of Last Tax Period (VAT) 52 87,983.18
Closing Balance of Last Tax Period (SD) 53

Part-8: ADJUSTMENT FOR OLD ACCOUNT CURRENT BALANCE

Item Note Amount(Tax)
Remaining Balance (VAT) from Mushak–18.6, [ Rule 118(5)] 54 Opening Balance of VA
Remaining Balance (SD) from Mushak–18.6, [ Rule 118(5)] 55 - N/A for ceat
Decreasing Adjustment for Note 54 (up to 10% of Note 34) 56
Decreasing Adjustment for Note 55 (up to 10% of Note 36) 57 -

Part-9: ACCOUNTS CODE WISE PAYMENT SCHEDULE (TREASURY DEPOSIT)

Item Note Economic Code Amount
VAT Deposit for the Current Tax Period 58 1 / 1133 /……0010….../ 0311 44,715 Sub-form
SD Deposit for the Current Tax Period 59 1 / 1133 /………... / 0721 - Sub-form
Excise Duty 60 1 / 1133 /……….../ 0601 - Sub-form
Development Surcharge 61 1 / 1103 / 0000 / 2225 - Sub-form
ICT Development Surcharge 62 1 / 1103 / 0000 / 2214 - Sub-form
Health Care Surcharge 63 1 / 1103 / 0000 / 2212 - Sub-form
Environmental Protection Surcharge 64 1 / 1103 / 0000 / 2213 - Sub-form

Part-10: CLOSING BALANCE

Item Note Amount
Closing Balance (VAT) [58-(50+67) + The refund amount not approved] 65 87,982.88
Closing Balance (SD) [59-(51+68) + The refund amount not approved] 66 -

Part-11: REFUND
I am interested to get refund of my Closing Balance Items Note Yes No
Requested Amount for Refund (VAT) 67
Requested Amount for Refund (SD) 68

Part-12: DECLARATION
I hereby declare that all information provided in this Return Form are complete, true & accurate. In case of any untrue/incomplete statement, I may be subjected to
penal action under The Value Added Tax and Supplementary Duty Act, 2012 or any other applicable Act prevailing at present.

Name : MD. Habib Ullah

Designation : Proprietorship
Mobile Number : ,01713-007145
National ID/Passport Number :
Email :
Signature :

Page 2 of 11
Sub Form (For Note No-1,2,3,4,5,6,7,10,11,12,13,14,15,16,17,19,20,21 and 22 )
SL No Commercial description of Good/Service Goods/Service Code Goods/Service Name Value (a) SD(b) VAT(c) Notes
Filter Paper Uncoated 4805.40.00 Filter Paper Uncoated 2682381.71 402357.26 Import Purches

2682381.71 402357.26
Sub Form (For Note No- 6 and 18 )
Actual
SL No Good/Service Commercial description Goods/Service Code Goods/Service Name Unit of Measures (a) Quantity (b) Sales/Purachase SD(d) VAT(e) Notes
Value(c)
Sub Form (For Note No- 8 )
SL No Category Good/Service Commercial description Goods/Service Code Goods/Service Name Value (a) SD(b) VAT(c) Notes
1 Commercial Importer/Other Traders Filter Paper Uncoated 4805.40.00 Filter Paper Uncoated 3576687.89 178834.39 Sale Of 5%
2 Petroleum Products

3 Super-shop
4 Medicine related Products 3576687.89 178834.39
Sub-form (For Note-24 )
VAT
VAT Deduction Tax Tax
Deduction Tax deposit serial
Invoice No/Challan/Bill No- Invoice/Challan/Bill at source, deposit deposit
SL No Supplier's BIN Supplier's Name Supplier's Address Value Deducted VAT at source, number of Book Notes
etc.) Date Certificate Account date
Certificate transfer
No Code
date

1
Sub-form (For Note-29 )
VAT
VAT Deduction Tax Tax
Deduction Tax deposit serial
Invoice No/Challan/Bill No- Invoice/Challan/Bill at source, deposit deposit
SL No Buyer's BIN Buyer's Name Buyer's Address Value Deducted VAT at source, number of Book Notes
etc.) Date Certificate Account date
Certificate transfer
No Code
date
Sub-form (For Note-30 )
SL No Bill of Entry Number Date Customs House/Customs Station Advance Tax amount Notes

1 C-1435386 10/18/2020 Chittagong 112274.91 AT

2 C-1296967 9/24/2020 Chittagong 122280.84 AT

234555.75
Sub-form (For Note-58,59,60,61,62,63 and 64 )
SL No Treasury Challan Number Bank Branch Date Tax Deposit Account Code Amount Notes
1 T- Sonali Bank 11133.0010.0311 44715 VAT

44715

Sub-form (For Note-30 )

Advance
Customs
SL No Bill of Entry Number Date Tax Notes
House/Customs Station
amount
1 C -796288 16/05/2021 Chittagong 134119.09 AT

134119.09